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C Boult

Publications and source records attributed to C Boult.

33 records · Page 2Linked to original sources
PubMed1996

Decreasing disability in the 21st century: the future effects of controlling six fatal and nonfatal conditions.

OBJECTIVES: This study assessed the effects of reducing fatal and nonfatal health conditions on the number of functionally limited older Americans in the coming decades. METHODS: Data from the 1990 census and the Longitudinal Study of Aging were used to project the number of functionally limited older Americans from 2001 to 2049, assuming 1% biennial reductions in five conditions that shorten life expectancy (coronary artery disease, stroke, cancer, diabetes, and confusion) and one condition that decreases functional ability (arthritis). RESULTS: Decreasing the prevalence of arthritis by 1% every 2 years would lead to a much greater reduction in functional limitation between 2001 and 2049 (4 million person-years) than would decreasing any of the other conditions by the same amount. Decreases in two fatal conditions (cancer and coronary artery disease) would lead to increases in functional limitation (0.9 and 0.1 million person-years, respectively). CONCLUSIONS: Advances against common nonfatal disabling conditions would be more effective than advances against fatal conditions in blunting the large increase in the functionally limited older population anticipated in the 21st century.

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PubMed1995

Targeting elders for geriatric evaluation and management: reliability, validity, and practicality of a questionnaire.

Geriatric evaluation and management (GEM) is most cost-effective when provided to persons at high risk for functional decline or heavy use of health services. Identifying high risk members of elderly populations is, therefore, the first step in conducting successful GEM programs. We have developed and tested a mailed, self-administered, eight-item questionnaire to identify home-dwelling elders at risk for heavy use of hospitals. Scored by a logistic formula, this questionnaire estimates each respondent's probability of repeated admission (Pra) to a hospital within four years. Its primary purpose is to help select elders who are likely to benefit from outpatient GEM. We created this instrument by analyzing data from half the subjects in the Longitudinal Study of Aging (LSOA); its test-retest reliability is high (r = 0.78). In a preliminary test of its predictive validity among the other half of the LSOA subjects, the instrument prospectively identified high-risk elders who went on to use hospitals at twice the rate of their lower-risk peers. In a separate study of its predictive validity among low-income urban elders, the instrument again identified a high-risk group that went on to use hospital days at twice the rate of its lower-risk counterpart. In a pilot study, we used the questionnaire to identify potential recipients of outpatient GEM. The identified elders appeared to be appropriate candidates for GEM. They averaged 9.6 significant medical problems, 6.7 significant prescription medications, and two IADL limitations. We are now using this instrument to identify subjects for a randomized clinical trial of outpatient GEM

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PubMed1995

Predictive validity of a questionnaire that identifies older persons at risk for hospital admission.

OBJECTIVE: To determine the predictive validity of a mailed questionnaire designed to measure older adults' risk of repeated hospitalization. DESIGN: Prospective cohort study. SETTING: Ramsey County, Minnesota. PARTICIPANTS: Medicaid recipients aged 70 and older who completed the questionnaire. MEASUREMENTS: Responses were used to calculate the subjects' probability of repeated admission (Pra) to hospitals within 4 years. Subjects were classified as low-risk (Pra < 0.5) or high risk (Pra > or = 0.5). One year later, Medicaid claims data were analyzed to determine the subjects' actual use of hospitals. RESULTS: One-fifth of the respondents (20.6%) were classified as high-risk at baseline. During the following year, the high-risk subjects used hospitals at approximately twice the rate of the low-risk subjects (4.5 vs 2.4 days/person-year, P = .009). CONCLUSIONS: The instrument, which was previously found to be valid in a national sample of Medicare beneficiaries, appears to be valid also in a local sample of Medicaid beneficiaries. Older adults at risk of heavy hospital use can be identified prospectively through their responses to this brief, mailed, self-administered questionnaire. The instrument may be useful in targeting older persons for interventions designed to prevent the need for hospital care.

Age Factors↗
PubMed1994

Chronic conditions that lead to functional limitation in the elderly.

BACKGROUND: The role of chronic medical conditions in elderly persons' loss of functional abilities is intuitively important but not well defined. This analysis was designed to identify chronic medical conditions that lead to the development of severe functional limitation. METHODS: Functionally intact members of a multistage probability sample (n = 6,862) of all noninstitutionalized U.S. civilians age 70 years or older were interviewed in 1984. Based on data from the National Death Index and from follow-up telephone interviews in 1988 with survivors, subjects were classified as functionally intact, functionally limited (unable to perform one or more of seven essential activities), or decreased. RESULTS: After adjusting for the effects of exercise habits and demographic, socioeconomic, and psychosocial factors, we found that the best predictors of the development of functional limitation were cerebrovascular disease (OR = 2.14; 95% CL = 1.16, 3.98) and arthritis (OR = 1.51; 95% CL = 1.08, 2.11). The contribution of coronary artery disease also approached statistical significance (OR = 1.49; 95% CL = 0.99, 2.27). CONCLUSION: In the future, the primary prevention or effective treatment of cerebrovascular disease, arthritis, and possibly coronary artery disease may produce a modest reduction in the incidence of severe functional limitation.

Activities of Daily Living↗
PubMed1994

A method for increasing elders' use of advance directives.

Most published studies report that few elderly people have recorded advance directives (AD). We studied the effectiveness of an interdisciplinary intervention designed to help ambulatory frail elders to record AD. In collaboration with physicians and a trained lay volunteer, a social worker provided information and counseling to the elderly subjects, to their families, and to their proxies in a series of visits to a geriatric evaluation and management (GEM) clinic. Seventy-one percent of the subjects recorded AD. Of these, 96% named a proxy, and 83% recorded specific treatment preferences.

Advance Directives↗
PubMed1994

A controlled trial of outpatient geriatric evaluation and management.

OBJECTIVE: To evaluate the effects of targeted outpatient geriatric evaluation and management (GEM). DESIGN: Controlled clinical trial. Elderly persons were identified as being at high risk for hospital admission on the basis of their responses to a short, mailed, self-administered questionnaire. The high-risk elders who chose to participate in the GEM program were compared to those who continued to receive usual care. SETTING: Outpatient GEM clinic at an urban university hospital. SUBJECTS: Elderly Medicaid recipients whose probability of repeated hospital admission (Pra) within 4 years was calculated as 40% or greater (Pra > or = 0.40). MAIN OUTCOME MEASURES: Mortality, use of institutional services, satisfaction. RESULTS: Of the 1210 persons who were sent questionnaires, 624 responded (response rate = 51.6%), of whom 154 (24.7%) were deemed to be a high risk for hospitalization. Of these, 43 received GEM (experimental subjects); 111 received usual care (controls). At baseline, the experimental and control groups' demographic and health-related characteristics did not differ significantly. The average experimental subject was 76.5 years old, had 9.6 significant medical problems, and took 6.7 significant long-term prescription medications. During the program's first 17 months of follow-up, the experimental subjects had lower annual rates of mortality (2.9% vs 19.2%, P = 0.03) and emergency room use (0.6 vs 1.0 visits, P = 0.01) than did the controls. The experimental subjects also tended to use nursing homes, but not hospitals, at a lower rate than the controls. All of the experimental subjects rated the program as either excellent (81.0%) or good (19.0%); 100% said they would recommend it to others. Their established primary physicians rated the GEM services as appropriate and helpful. CONCLUSION: Targeted outpatient GEM was associated with reduced mortality, reduced use of emergency rooms, and a trend toward reduced use of nursing homes.

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PubMed1994

Test-retest reliability of a questionnaire that identifies elders at risk for hospital admission.

OBJECTIVE: To determine the test-retest reliability of a questionnaire designed to measure elderly persons' probability of repeated admission (P(ra)) to a hospital within 4 years. DESIGN: Participants received the test questionnaire by mail; respondents to the test questionnaire received the retest questionnaire 3 weeks later. PARTICIPANTS: Elderly (65+) community-dwelling enrollees in the Medical Assistance (Medicaid) program of Ramsey County, MN (n = 192). MAIN OUTCOME MEASURE: The correlation (r) between the P(ra) values computed from the test-retest correlations (k) of the questionnaire's individual items were also measured. RESULTS: The response rate was 63% (121/192) for the test questionnaire and 69% (84/121) for the retest questionnaire. The test and retest values of P(ra) computed from responses to the questionnaires were highly correlated (r = 0.78, P < 0.0001). For the individual questionnaire items, the range of k values was 0.50-1.00 (P < 0.0001 for all items). Slightly higher values of r and k were obtained when the respondents were women and when the same person (either proxy or self) completed both questionnaires. Age was not consistently related to reliability. CONCLUSION: the test-retest reliability of individual items and of the computed P(ra) was high, suggesting that responses by elderly persons to mailed questionnaires pertaining to health status are stable over brief periods of time. The resulting P(ra) values may be useful in identifying elders at high risk for hospital admission.

Age Factors↗
PubMed1993

Screening elders for risk of hospital admission.

OBJECTIVE: To define a set of screening criteria that identifies elders who are at high risk for repeated hospital admission in the future. DESIGN: Longitudinal cohort study. Logistic regression analysis of data from half of the subjects was used to identify risk factors for repeated hospital admission. The ability of these risk factors to identify elders who are at high risk for repeated hospitalization in the future was then tested using data from the other half of the subjects. SETTING: United States. PARTICIPANTS: A subsample (n = 5876) of a multistage probability sample of all non-institutionalized U.S. civilians who were 70 years or older in 1984. MEASUREMENTS: At baseline (1984), elderly subjects were asked about their demographic, socioeconomic, medical, and functional characteristics and about their recent use of health services. Their subsequent hospital admissions and mortality were then monitored through the records of the Medicare program and the National Death Index (1985-88). RESULTS: Among the subjects in the first half of the sample, eight factors emerged as risk factors for repeated admission: older age, male sex, poor self-rated general health, availability of an informal caregiver, having ever had coronary artery disease, and having had, during the previous year, a hospital admission, more than six doctor visits, or diabetes. Based on the presence or absence of these factors in 1984, 7.2% of the subjects in the second half of the sample were estimated to have a high probability of repeated admission (Pra > or = 0.5) during 1985-1988. In comparison with subjects estimated to have a low risk (Pra < 0.5), this high-risk group's actual experiences during 1985-1988 included a higher cumulative incidence of repeated admission (41.8% vs 26.2%, P < 0.0001), a higher cumulative rate of mortality (44.2% vs 19.0%, P < 0.0001), more hospital days per person-year survived (5.2 vs 2.6), and higher hospital charges per person-year survived ($3731 vs $1841). CONCLUSION: Eight easily ascertained risk factors affect elders' probability of being hospitalized repeatedly within four years. In the future, brief surveys about the presence of these factors could be used to estimate elders' risk of future hospitalization and, thereby, to identify some of those who may derive the greatest benefit from interventions designed to avert the need for hospitalization.

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PubMed1991

Forecasting the number of future disabled elderly using Markovian and mathematical models.

The accuracy of forecasting the number of future disabled elderly people depends on the accuracy of projecting mortality rates and the rates of transition to and from functional disability. We describe a new two-step method for constructing mathematical models that project these future rates dynamically. (1) A Markovian model of elders' transitions between functional states is specified. (2) A mathematical model of the probability of each transition is created. We conducted pilot studies of the fundamental mathematical processes of this method using data from the Longitudinal Study of Aging. First we constructed prototypic mathematical models of the probabilities of remaining functionally able and of making transitions to disability and to death within 2 years. Then we used these models to project hypothetical rates of transition for white women of selected ages, morbidity ratings and health statuses.

Activities of Daily Living↗
PubMed1991

The relation of dizziness to functional decline.

OBJECTIVE: to assess the effect of dizziness on the probability that an older person will die or become functionally disabled within 2 years. Dizziness is a common symptom for which the prognosis is uncertain. This report compares the prognoses for dizzy and not-dizzy older people in order to assist clinicians who diagnose and treat these patients. DESIGN: a prospective study of a representative sample of elderly (70+) non-institutionalized Americans. Elderly subjects (n = 3,798) in the Longitudinal Study of Aging (LSOA) were asked questions about the presence of dizziness, medical conditions, and functional disability in 1984. The cohort was reinterviewed about functional disability in 1986. OUTCOME MEASURE: transition from functional ability to disability after 2 years. RESULTS: Bivariate analyses showed that dizziness predicts functional decline but not mortality. Multivariate models revealed that age, race, sensory impairment, vascular disease, and other morbidity are independent predictors of becoming disabled. Controlling for these potential confounders, dizziness does not predict an increased probability of becoming disabled. CONCLUSION: Elderly people who are dizzy should be evaluated for the presence of these related conditions.

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